Outcomes of Living Donor Liver Transplant in Elevated Body Mass Index over a Decade in the United States - 10/04/25

Doi : 10.1016/j.liver.2025.100274

Marie L Jacobs ^a,^⁎ , Matthew Byrne ^a, Xueya Cai ^b, Shan Gao ^b, John Martens ^a, Luis I Ruffolo ^a, Ana Paula Cupertino ^a,^c, Karen Pineda-Solis ^a
^a University of Rochester Medical Center, Department of Surgery, 601 Elmwood Ave, Rochester, NY 14642
^b University of Rochester Medical Center, Department of Biostatistics and Computational Biology, 601 Elmwood Ave, Rochester, NY 14642
^c University of Rochester Medical Center, Department of Public Health Sciences, 601 Elmwood Ave, Rochester, NY 14642

^⁎Corresponding Author

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Highlights

•	Recipient obesity is not associated with worse graft survival.
•	Recipient obesity is not associated with higher rates of death.
•	An obesity paradox may be at play in living donor liver transplant.
•	Patients of all sizes should be considered for living donor liver transplant.

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Abstract

Introduction

: Living donor liver transplant (LDLT) is a treatment option for end stage liver disease (ESLD). This study assesses the impact of recipient BMI on LDLT outcomes.

Methods

: The United Network for Organ Sharing (UNOS) database was reviewed for adult LDLTs between January 2010 and December 2020. Recipients were stratified by BMI: Normal: < 25 kg/m²; Overweight: 25 to <30 kg/m², Class 1 Obesity: 30 to <35 kg/m², and Class 2/3 Obesity: ≥35 kg/m². Recipient and donor characteristics, and post-transplant graft failure and mortality were compared.

Results

: 3068 patients were included. The mean age was 53 ± 13 years. The prevalence of diabetes and MASH cirrhosis was positively correlated with higher BMI groups (p<0.0001 and p<0.0001). At 5-years, graft failure (GF) in each group was 7.7%, 5.2%, 4.2%, and 3.5%, respectively (p = 0.0091). At 5 years, rate of death in each group was 11.2%, 12.5%, 10.7%, and 10.4%, respectively (p = 0.61). After controlling for patient demographics, clinical characteristics, and donor age, weight was no longer associated with graft failure or death.

Conclusion

: In this retrospective analysis, recipient BMI did not correlate with death, and obesity is associated with lower rates of graft failure. Obesity alone should not preclude candidacy for LDLT.

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Keywords : living donor liver transplant, obesity, BMI, health disparities